Gastro Intestinal System

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GASTROINTESTINAL SYSTEM

PROCEDURES

GASTROINTESTINAL GASTROINTESTINAL SYSTEMSYSTEM

PROCEDURESPROCEDURES

Gary D. Morrison, M.Ed., R.T.(R)Associate Professor, Radiologic Sciences

Midwestern State University

GASTROINTESTINAL SYSTEM PROCEDURESGASTROINTESTINAL SYSTEM PROCEDURESSimilarities

Comparable densities requires use of contrast media.Require use of fluoroscopy.Technologist also uses overhead tube to produce plain films.

VariablesStructures vary greatly in shape, size, and location depending on body habitus.Great variation in “normal” function.

GASTROINTESTINAL SYSTEM PROCEDURESGASTROINTESTINAL SYSTEM PROCEDURESContrast Media

PositiveBarium Sulfate (BaSO4).

—Most common—Can not be used with perforation—Suspension not solution

Non-injectible, water-soluble Iodine (Oral) -generally used when barium is contraindicated.

NegativeNormally air or CO2.Used to give double-contrast.

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Contrast MediaMixing of Barium

Thin—Used for UGI & SBS—Moves faster - actual speed depends on

suspending media temperature, consistency, & condition of GI tract

Thick—Used to coat (barium swallow & BE)—Moves slowly

Barium must be stirred before useExact thickness will be determined by the radiologist & dept. protocol

GASTROINTESTINAL SYSTEM PROCEDURESGASTROINTESTINAL SYSTEM PROCEDURES

GASTROINTESTINAL SYSTEM PROCEDURESGASTROINTESTINAL SYSTEM PROCEDURESContrast Media

Contraindications/AlternatesThe use of barium is contraindicated in the following:

—Perforated viscous—Pre-op

When barium is contraindicated, use non-injectible, water-soluble Iodine (Oral) contrast

—Gastrografin—Oral Hypaque

Barium can cake in GI tract—Force fluids—Use laxatives & enemas as necessary

GASTROINTESTINAL SYSTEM PROCEDURESGASTROINTESTINAL SYSTEM PROCEDURES

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GI SYSTEM PROCEDURES -ESOPHAGRAM (BARIUM SWALLOW)GI SYSTEM PROCEDURES -ESOPHAGRAM (BARIUM SWALLOW)

Examination ofPharynx (distal 2/3)Esophagus

Looks atAnatomical structureSwallowing function

Patient PreparationNo prepPt. removes clothing, jewelry, glasses, & dentures


Room PreparationRoom cleanBarium mixed - thick & thinFluoro set upSpot film cassettes/cameras readyTable in upright position with foot board in place

GI SYSTEM PROCEDURES -ESOPHAGRAM (BARIUM SWALLOW)GI SYSTEM PROCEDURES -ESOPHAGRAM (BARIUM SWALLOW)Fluoro Routine

General survey of chest & abdomenDeglutition observed

UprightPA/APObliques

RecumbentOptional

TrendelenburgValsalvaWater testToe-touch

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Overhead RoutineUse thick BariumUpright or recumbentStandard positions

RAOPA/APLt. Lateral


RAOMSP 35°- 40° to filmCR 2” lat. Of MSPShield gonads

GI SYSTEM PROCEDURES -ESOPHAGRAM (BARIUM SWALLOW)GI SYSTEM PROCEDURES -ESOPHAGRAM (BARIUM SWALLOW)PA/AP

Center MSP to filmArms at sideTurn head slightlyShield gonads

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GI SYSTEM PROCEDURES -ESOPHAGRAM (BARIUM SWALLOW)GI SYSTEM PROCEDURES -ESOPHAGRAM (BARIUM SWALLOW)Lt. Lateral

Arms forwardCenter MSP to filmCR - T5-T6Shield gonads

GI SYSTEM PROCEDURES -CARDIAC SERIESGI SYSTEM PROCEDURES -CARDIAC SERIESTo Determine the Size & Shape of the Heart.No FluoroThick Barium72” FFD - ErectFour (4) Positions

PALt.. Lateral45o RAO60o LAO

GI SYSTEM PROCEDURES -UPPER GI SERIES (UGI)GI SYSTEM PROCEDURES -UPPER GI SERIES (UGI)

Examination of Distal Esophagus, Stomach, & DuodenumPatient Preparation

NPO for 8-12 hoursNo smokingNo gum chewing

For exam, patient must remove clothing, jewelry, glasses, & dentures

Room Preparation - As Previously Discussed

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GI SYSTEM PROCEDURES -UPPER GI SERIES (UGI)GI SYSTEM PROCEDURES -UPPER GI SERIES (UGI)Fluoro Routine - Generally Starts As for the Barium Swallow & Then Progresses According to Radiologist & Dept. ProtocolOverhead Routine - Completed After Fluoro According to Radiologist & Dept. Protocol

RAOPARt. LateralLPO


RAO - 40°- 70°Varies with size, shape, & position of stomachShield gonads


PACR-mid-way between spine & Lt. lat. border at level of L1-L2Shield gonads

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Rt. LateralCR - midway between MCP & ant. Border at level of L1-L2Shield gonads


LPO - 45° (30°- 60°)CR-mid way between spine & Lt. lat. border at level of L1-L2Shield gonads

To Study Radiographically the Structure & Function of the Three Parts of the Small Intestine & to Detect AbnormalitiesPatient Preparation

Light meal night beforeNPO for 8-12 hoursNo smoking or gum chewingLaxative or enema (optional)For exam, patient must remove clothing -including underwear

GI SYSTEM PROCEDURES -SMALL BOWEL SERIESGI SYSTEM PROCEDURES -SMALL BOWEL SERIES

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IndicationsEnteritis - inflammation of the mucousal & submucousal tissues of the intestinesNeoplasms - a new & abnormal formation of tissue which serves no useful function

BenignMalignant

Various malabsorption syndromesIleus - obstruction

Adynamic/ParalyticMechanical


ContraindicationsPerforationPre-opLarge intestine obstruction

May Be Performed AsSmall bowel series onlyUGI with small bowel follow-throughAccelerated small bowel - cold salineSmall bowel enema (enteroclysis)Retrograde small bowel - reflux method

GI SYSTEM PROCEDURES -SMALL BOWEL SERIESGI SYSTEM PROCEDURES -SMALL BOWEL SERIESImaging

Overheadsfilms at 30 min. intervals until barium reaches ileocecal valve(usually 2 hrs.)CR - MSP at level ofL2 for early films, iliaccrest for delayed films

Fluoro & spot filmsoptionalwhen barium reachesthe ileocecal valve

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GI SYSTEM PROCEDURES -BARIUM ENEMAGI SYSTEM PROCEDURES -BARIUM ENEMA

To Study the Structure & Function of the Large Intestines & Detect AbnormalitiesIndications

AppendicitisColitis - inflammation of the colonDiverticulosis/itis - outpouching of bowel wall/with inflammationIntussusception - collapse of bowel into itselfNeoplasm - benign or malignantVolvulus - twisting of bowel on itself

GI SYSTEM PROCEDURES -BARIUM ENEMAGI SYSTEM PROCEDURES -BARIUM ENEMAPatient Preparation

Same as UGI, plusLaxative - mandatory

Types—Irritant - castor oil—Saline-based magnesium

citrate or magnesium sulfateContraindications

—GI bleeding—Diarrhea—Obstruction—Inflammatory lesions

Cleansing enema - optional

GI SYSTEM PROCEDURES -BARIUM ENEMAGI SYSTEM PROCEDURES -BARIUM ENEMAContrast Media

Single - Positive, usually BariumDouble

Used to show small growths such as polypsPositive & negative, usually Barium & Air

Contrast Media AdministrationClosed-bag system

Self-containedDisposableAllows mixing of BariumAllows for drainage

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Contrast Media AdministrationOpen system

ReusableBlood-body fluid hazardSpill hazard

Enema tips & rectal tubesStraight - disposableRetention tip - disposableRectal catheter with balloon - reusable


Room PreparationTable horizontal - footboard optionalBucky tray at foot of tableBarium mixed according to protocolFluoro tower set up with overhead tube out of the waySpot film cassettes/camera readyGood supply of gloves & towelsMop & bucket


General RoutinePrepare the patient

Explain the exam—Encourage relaxation—Deep breaths through mouth

Have pt. change - everythingScoutInsert enema tip

ExplainSims positionLubricate tip

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Fluoro RoutineMaintain tension on enema tipCommunicateTurn barium on & offChange spot filmsFluoro routine will vary with radiologist & institution


Overhead RoutineSingle contrast BE - completed after fluoro

AP/PA projectionRAO positionLAO positionAP/PA axial projectionOPTIONAL - Rt. &/or Lt. LateralPost-evacuation AP/PA projection

GI SYSTEM PROCEDURES -BARIUM ENEMAGI SYSTEM PROCEDURES -BARIUM ENEMAAP/PA Projection

CR - MSP at level of iliac crestShield gonads

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GI SYSTEM PROCEDURES -BARIUM ENEMAGI SYSTEM PROCEDURES -BARIUM ENEMARAO - 35°- 45°

CR - 1”-2” lat. to midline on elevated side at level of iliac crestShield gonads


LAO - 35°- 45°CR - 1”-2” lat. to midline on elevated side at level of iliac crestShield gonads

GI SYSTEM PROCEDURES -BARIUM ENEMAGI SYSTEM PROCEDURES -BARIUM ENEMAAP/PA Axial

AP - CR - 30°- 40° cephalad at MSP & ASISPA -CR - 30°- 40° caudal at MSP & ASIS

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GI SYSTEM PROCEDURES -BARIUM ENEMAGI SYSTEM PROCEDURES -BARIUM ENEMALateral Rectum

CR - MCP at level of ASIS

GI SYSTEM PROCEDURES -BARIUM ENEMAGI SYSTEM PROCEDURES -BARIUM ENEMAPost-evacuation

Same as AP/PA

GI SYSTEM PROCEDURES -BARIUM ENEMA WITH AIRGI SYSTEM PROCEDURES -BARIUM ENEMA WITH AIR

Overhead RoutineBE with air (double contrast) - completed after fluoro for instillation of air

Repeat all or part of single-contrast routine, plusAP/PA projection - bothRt. Lateral Decubitus positionLt. Lateral Decubitus position

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GI SYSTEM PROCEDURES -BARIUM ENEMA WITH AIRGI SYSTEM PROCEDURES -BARIUM ENEMA WITH AIRRt. Lat. Decubitus

Horizontal CR at MSP & iliac crest

GI SYSTEM PROCEDURES -BARIUM ENEMA WITH AIRGI SYSTEM PROCEDURES -BARIUM ENEMA WITH AIRRt. Lat. Decubitus

Horizontal CR at MSP & iliac crest

Gastro Intestinal System

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